Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY, United States.
Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY, United States.
Cancer Epidemiol. 2020 Jun;66:101710. doi: 10.1016/j.canep.2020.101710. Epub 2020 Apr 1.
We investigated the influence preexisting type 2 diabetes mellitus (T2DM) and antidiabetic drugs have on all-cause and cause-specific mortality among Medicaid-insured women diagnosed with breast cancer.
9221 women aged <64 years diagnosed with breast cancer and reported to the New York State (NYS) Cancer Registry from 2004 to 2016 were linked with Medicaid claims. Preexisting T2DM was determined by three diagnosis claims for T2DM with at least one claim prior to breast cancer diagnosis and a prescription claim for an antidiabetic drug within three months following breast cancer diagnosis. Estimated menopausal status was determined by age (premenopausal age <50; postmenopausal age ≥50). Hazard ratios (HR) and 95 % confidence intervals (95 %CI) were calculated with Cox proportional hazards regression, adjusting for confounders.
Women with preexisting T2DM had greater all-cause (HR = 1.40; 95 %CI 1.21, 1.63), cancer-specific (HR = 1.24; 95 %CI 1.04, 1.47), and cardiovascular-specific (HR = 2.46; 95 %CI 1.54, 3.90) mortality hazard compared to nondiabetic women. In subgroup analyses, the association between T2DM and all-cause mortality was found among non-Hispanic White (HR 1.78 95 %CI 1.38, 2.30) and postmenopausal (HR = 1.47; 95 %CI 1.23, 1.77) women, but not among other race/ethnicity groups or premenopausal women. Additionally, compared to women prescribed metformin, all-cause mortality hazard was elevated among women prescribed sulfonylurea (HR = 1.44; 95 %CI 1.06, 1.94) or insulin (HR = 1.54; 95 %CI 1.12, 2.11).
Among Medicaid-insured women with breast cancer, those with preexisting T2DM have an increased mortality hazard, especially when prescribed sulfonylurea or insulin. Further research is warranted to determine the role antidiabetic drugs have on survival among women with breast cancer.
我们研究了在纽约州医疗补助保险的女性乳腺癌患者中，先前存在的 2 型糖尿病（T2DM）和抗糖尿病药物对全因和特定原因死亡率的影响。
2004 年至 2016 年间，从纽约州癌症登记处报告的 9221 名年龄<64 岁的乳腺癌女性与医疗补助索赔相关联。先前存在的 T2DM 通过三个 T2DM 诊断要求确定，至少有一个诊断要求在乳腺癌诊断前，并且在乳腺癌诊断后三个月内有一个抗糖尿病药物处方要求。估计的绝经状态通过年龄确定（绝经前年龄<50；绝经后年龄≥50）。使用 Cox 比例风险回归计算风险比（HR）和 95%置信区间（95%CI），并调整混杂因素。
与非糖尿病女性相比，患有先前存在的 T2DM 的女性全因死亡率（HR=1.40；95%CI 1.21，1.63）、癌症特异性死亡率（HR=1.24；95%CI 1.04，1.47）和心血管特异性死亡率（HR=2.46；95%CI 1.54，3.90）的风险更高。在亚组分析中，在非西班牙裔白人（HR 1.78 95%CI 1.38，2.30）和绝经后（HR=1.47；95%CI 1.23，1.77）女性中，T2DM 与全因死亡率之间存在关联，但在其他种族/族裔群体或绝经前女性中不存在关联。此外，与服用二甲双胍的女性相比，服用磺酰脲（HR=1.44；95%CI 1.06，1.94）或胰岛素（HR=1.54；95%CI 1.12，2.11）的女性全因死亡率危险度升高。
在纽约州医疗补助保险的乳腺癌女性中，先前存在的 T2DM 患者死亡率风险增加，尤其是服用磺酰脲或胰岛素的患者。需要进一步研究以确定抗糖尿病药物在乳腺癌女性中的生存作用。
